Inanspruchnahme kostenfreier verschreibungspflichtiger Verhütungsmittel durch Frauen

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Der Bezug staatlicher Transferleistungen (STL) in Deutschland ist mit dem Verzicht auf sichere Verhütung assoziiert. Die...     

The effectiveness of respiratory protection worn by communities to protect from volcanic ash inhalation. Part II: Total inward leakage tests

Inhalation of ash can be of great concern for affected communities, during and after volcanic eruptions. Governmental and humanitarian agencies recommend and distribute a variety of respiratory protection (RP), most commonly surgical masks. However, there is currently no evidence on how effective such masks are in protecting wearers from volcanic ash. In Part I of this study (Mueller et al., 2018), we assessed the filtration efficiency (FE) of 17 materials from different forms of RP against volcanic ash and a surrogate, low-toxicity dust, Aloxite. Based on those results, we now present the findings from a volunteer simulation study to test the effect of facial fit through assessment of Total Inward Leakage (TIL).Four different disposable RP types that demonstrated very high median FE (≥96% for Aloxite; ≥89% for volcanic ash) were tested without provision of training on fit. These were an industry-certified mask (N95-equiv.); a surgical mask from Japan designed to filter PM_2.5; a flat-fold basic mask from Indonesia; and a standard surgical mask from Mexico, which was also tested with an added medical bandage on top, as an additional intervention to improve fit.Ten volunteers (6 female, 4 male) were recruited. Each RP type was worn by volunteers under two different conditions simulating cleaning-up activities during/after volcanic ashfall. Each activity lasted 10?min and two repeats were completed for each RP type per activity. Dust (as PM_2.5) concentration inside and outside the mask was measured with two TSI SidePak aerosol monitors (Models AM510 and AM520, TSI, Minnesota, USA) to calculate TIL. A questionnaire was administered after each test to collect perceptions of fit, comfort, protection and breathability.The best-performing RP type, across both activities, was the industry-certified N95-equiv. mask with 9% mean TIL. The standard surgical mask and the basic flat-fold mask both performed worst (35% TIL). With the additional bandage intervention, the surgical mask mean TIL improved to 24%. The PM_2.5 surgical mask performed similarly, with 22% TIL. The N95-equiv. mask was perceived to provide the best protection, but was also perceived as being uncomfortable and more difficult to breathe through.This study provides a first objective evidence base for the effectiveness of a selection of RP types typically worn around the world during volcanic crises. The findings will help agencies to make informed decisions on the procurement and distribution of RP in future eruptions.     

Urinary metal concentrations among mothers and children in a Mexico City birth cohort study

Personal care product use is a potential source of metals exposure among children, but studies have been limited. We measured urinary concentrations of 10 metals (aluminum, arsenic [As], barium [Ba], cadmium, cobalt [Co], lead [Pb], manganese [Mn], molybdenum [Mo], nickel, and zinc [Zn]) in third trimester pregnant women (n?=?212) and their children at 8–14 years of age (n?=?250). Demographic factors (child sex, age, socioeconomic status, and maternal education), body mass index (BMI) z-score, and child personal care product use in the 24?h prior to urine collection were examined as predictors of urinary metal concentrations. Metals were detected in 80–100% of urine samples, with significant differences in maternal versus childhood levels. However, metal concentrations were not strongly correlated within or between time points. In linear regression models including all demographic characteristics, BMI z-score, and specific gravity, age was associated with higher Co (6% [95% CI: 2, 10]), while BMI z-score was associated with lower Mo (-6% [95% CI: -11, -1). In addition, significantly higher metal concentrations were observed among users of colored cosmetics (Mo: 42% [95% CI: 1, 99]), deodorant (Ba: 28% [3, 58]), hair spray/hair gel (Mn: 22% [3, 45]), and other toiletries (As: 50% [9, 108]), as well as with an increasing number of personal care products used (As: 7% [3, 11]) after adjustment for child sex, age, total number of products used, and specific gravity. However, significantly lower metal concentrations were noted for users of hair cream (As and Zn: -20% [-36, -2] and -21% [-35, -2], respectively), shampoo (Pb: -40% [-62, -7]), and other hair products (Pb: -44% [-65, -9]). We found that personal care product use may be a predictor of exposure to multiple metals among children. Further research is recommended to inform product-specific exposure source identification and related child health risk assessment efforts.     

Economic evaluation of telephone-based weight loss support for patients with knee osteoarthritis: a randomised controlled trial

Background

The prevalence of knee osteoarthritis is increasing worldwide. Obesity is an important modifiable risk factor for both the incidence and progression of knee osteoarthritis. Consequently, international guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight. However, few overweight patients with this condition receive care to support weight loss. Telephone-based interventions are one potential solution to provide scalable care to the many patients with knee osteoarthritis. The objective of this study is to evaluate, from a societal perspective, the cost-utility and cost-effectiveness of a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese.

Methods

An economic evaluation was undertaken alongside a pragmatic randomised controlled trial. Between May 19 and June 30, 2015, 120 patients with knee osteoarthritis were randomly assigned to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. Quality-adjusted life years (QALYs) was the utility measure and knee pain intensity, disability, weight, and body mass index (BMI) were the clinical measures of effect. Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. Data was collected at baseline, 6?weeks and 26?weeks. The primary cost-effectiveness analysis was performed from the societal perspective.

Results

Mean cost differences between groups (intervention minus control) were $493 (95%CI: -3513 to 5363) for healthcare costs, $-32 (95%CI: -73 to 13) for medication costs, and $125 (95%CI: -151 to 486) for absenteeism costs. The total mean difference in societal costs was $1197 (95%CI: -2887 to 6106). For QALYs and all clinical measures of effect, the probability of the intervention being cost-effective compared with usual care was less than 0.36 at all willingness-to-pay values.

Conclusions

From a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis.

Trial registration number

ACTRN12615000490572, registered 18th May 2015

     

An indoor air quality evaluation in a residential retrofit project using spray polyurethane foam

Understanding of indoor air quality (IAQ) during and after spray polyurethane foam (SPF) application is essential to protect the health of both workers and building occupants. Previous efforts such as field monitoring, micro-chamber/spray booth emission studies, and fate/transport modeling have been conducted to understand the chemical exposure of SPF and guide risk mitigation strategies. However, each type of research has its limitation and can only reveal partial information on the relationship between SPF and IAQ. A comprehensive study is truly needed to integrate the experimental design and analytical testing methods in the field/chamber studies with the mathematical tools employed in the modeling studies. This study aims to bridge this gap and provide a more comprehensive understanding on the impact of SPF to IAQ. The field sampling plan of this research aims to evaluate the airborne concentrations of methylene diphenyl diisocyanate (MDI), formaldehyde, acetaldehyde, propionaldehyde, tris(1-chlor-2-propyl)phosphate (TCPP), trans-1-chloro-3,3,3-trifluoropropene (Solstice^TM), and airborne particles. Modifications to existing MDI sampling and analytical methods were made so that level of quantification was improved. In addition, key fate and transport modeling input parameters such as air changes per hour and airborne particle size distribution were measured. More importantly, TCPP accumulation onto materials was evaluated, which is important to study the fate and transport of semi-volatile organic compounds. The IAQ results showed that after spray application was completed in the entire building, airborne concentrations decreased for all chemicals monitored. However, it is our recommendation that during SPF application, no one should return to the application site without proper personal protection equipment as long as there are active spray activities in the building. The comparison between this field study and a recent chamber study proved surface sorption and particle deposition is an important factor in determining the fate of airborne TCPP. The study also suggests the need for further evaluation by employing mathematical models, proving the data generated in this work as informative to industry and the broader scientific community.     

Requirement and supply of dental services in Victoria

The appropriateness of dental manpower has become a great uncertainty in the changing practice of dentistry. This paper presents research on the requirement for and supply of dental services in Victoria between 1984 and 1996. The requirement for dental services was found to be increasing due to population growth and higher per capita demand due to decreased endentulism. The supply of dental services was found to be mildly decreasing due to balanced supplementation and attrition processes and subtle sex ratio and age distribution changes among dentists. The resulting market excess, even after consideration of idle capacity and transfer of services supplied to dental therapists, provides a marked contrast to many, but not all, developed countries. It also offers an opportunity to shape occupational and specialty distribution to the advantage of dental professions and the public.     

Quantitative methylation analysis of resection margins and lymph nodes in oral squamous cell carcinoma

Resection is the preferred treatment for oral squamous cell carcinoma, and pathological staging of the resected specimen is crucial. The role of molecular biology in the diagnosis of minimal residual disease has not been fully investigated and may improve staging. Multiple adjacent specimens were taken from the tumour, the invasive front, the surgical margin, and the lymph nodes of 20 specimens from patients with oral cancer. Bisulphite-treated DNA from these specimens was assayed quantitatively with pyrosequencing methylation assays (PMA) of CpG islands within the gene promoters of the p16 and CYGB genes. Results were recorded with histopathological results, and compared with clinical outcome. Biological and technical replicates confirmed the reliability of the techniques. PMA upgraded 13 of the 20 surgical margins, 6 of which subsequently had a recurrent tumour. Not all of these recurrences were predicted and the effects of adjuvant treatment make firm conclusions difficult.